Jordan Gladys-Oryhon, DO, Moaz Sial, MD, Shifa Umar, MD, Raktima Goswami, MD
Allegheny Health Network, Pittsburgh, PA
Introduction: Urothelial carcinoma often manifests with painless gross or microscopic hematuria. Significant risk factors are mainly environmental including tobacco use, occupational exposures, and recurrent urinary tract infections. Metastatic disease often progresses via direct soft tissue invasion or lymphatic spread, with a paucity of reported cases of luminal colonic metastases. Here we describe a patient with concerning history for malignancy with multiple risk-factors, found to have luminal colonic metastases from primary urothelial carcinoma.
Case Description/Methods: A 51 y/o African-American male with medical history significant for HFrEF 15%, HTN, tobacco and alcohol abuse presented for outpatient colonoscopy, referred by his primary care physician for 6-month history of diarrhea and 30 lb weight loss. No prior colonoscopy performed. Family history was significant only for lung cancer in his paternal uncle. Colonoscopy was initially attempted with adult colonoscope, but was exchanged for an adult endoscope following inability to traverse >20 cm, secondary to thickened rectal folds also appreciated on rectal exam (Figure 1). Findings were significant for one 4mm sessile polyp of the transverse colon and segmental moderately congested, erythematous mucosa throughout the entire colon (Figure 1 and 2.). Pathology revealed new urothelial cancer with diffuse luminal colonic metastases. He completed staging work-up, found to have diffuse blastic, osseous bony metastases and was initiated on chemotherapy with further progression of his disease.
Discussion: Urothelial cancer often spreads via direct soft tissue invasion or lymphatic spread. Interestingly, our patient presented with advanced disease with atypical luminal colonic metastases, in the absence of direct invasion or soft tissue mass. The pathogenesis of metastasis remains unclear, but is likely related to lymphatic spread. In a thorough review of the literature, no other case of luminal colonic metastases from urothelial primary has been described. Any new change in bowel habit, warrants further evaluation with colonoscopy to rule out carcinoma of colonic or metastatic origin.
Citation: Jordan Gladys-Oryhon, DO, Moaz Sial, MD, Shifa Umar, MD, Raktima Goswami, MD. P0165 - LUMINAL COLONIC METASTASES FROM PRIMARY UROTHELIAL CARCINOMA. Program No. P0165. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.